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Sengupta T, Soni T, Bolock AM, Heisey SA, Kuchinski EC, Piper BJ, Joyce JM, Carbe CJ. Knowledge, Attitudes, and Beliefs of Medical Students Toward Transgender Healthcare: A Community-Driven Initiative. Cureus 2023; 15:e49992. [PMID: 38058529 PMCID: PMC10697781 DOI: 10.7759/cureus.49992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Transgender patients face substantial systemic healthcare barriers and inadequate care from providers who often demonstrate clinical gaps in the medical needs of the transgender community. Providing interventions in which affirming transgender healthcare is explored, is crucial to delivering competent transgender-patient care and building compassionate physician-patient relationships. The Northeast Pennsylvania (NEPA) Trans Health Conference was established to address the growing need for an educational forum where transgender people could voice their narratives. In this educational intervention study, changes in the knowledge, attitudes, and beliefs about the psychosocial and medical needs of the transgender community in first-year undergraduate medical students were examined pre- and post-trans health conference attendance. Materials and methods In the late spring of both 2018 and 2019, first-year medical students attended the NEPA Trans Health Conference, hosted by the Geisinger Commonwealth School of Medicine (GCSOM). Student knowledge, attitudes, and beliefs, regarding the healthcare needs of the transgender community were evaluated prior to and directly after the conference (intervention). Though the surveys shared thematic similarities, the 2018 and 2019 surveys were different and thus were not used comparatively. Results In 2018, 35.24% of first-year medical students (37/105 participants) completed both the pre- and post-survey. Overall, 62.5% (5/8) of survey items yielded significant differences. In 2019, 25.5%, of first-year medical students (28/110 participants) completed both the pre- and post-survey and 47.6% (9/21) of survey items yielded significant results. Overall, although the majority of first-year medical students displayed positive attitudes toward trans people pre-intervention, the students also demonstrated increased knowledge, empathy, and understanding of the transgender healthcare narrative post-intervention. Conclusion Providing medical students with a humanistic intervention within the medical curriculum that is focused on the transgender person, in addition to their past and present healthcare experiences, offers a bridge between academic content and providing inclusive gender-affirming healthcare to all patients.
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Affiliation(s)
- Tonoya Sengupta
- Department of Medical Education, St. George's University School of Medicine, St. George's, GRD
| | - Tripti Soni
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, USA
| | - Alexa M Bolock
- Department of Radiology, New York-Presbyterian Weill Cornell Medical College, New York, USA
| | - Sarah A Heisey
- Department of Medicine, Prisma Health Greenville Memorial Hospital, Greenville, USA
| | - Elizabeth C Kuchinski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Jennifer M Joyce
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Christian J Carbe
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
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2
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Affiliation(s)
- M Todd Brandt
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky, USA
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Tarasenko YN, Wackerbarth SB, Love MM, Joyce JM, Haist SA. Colorectal cancer screening: patients' and physicians' perspectives on decision-making factors. J Cancer Educ 2011; 26:285-293. [PMID: 20640779 DOI: 10.1007/s13187-010-0145-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
While patient barriers to colorectal cancer (CRC) screening have been identified, how well this knowledge is utilized during the patient-physician interaction is not fully understood. This study aims to assess among primary care physicians the degree of consensus between perceived and actual patients' CRC screening decision-making influential factors. During 2004-2006, 30 patients were interviewed to identify factors influencing screening decisions and 66 physicians were interviewed to understand what factors they thought were important to patients. The factors were categorized using the PRECEDE-PROCEED framework, and perspectives were compared. The researchers found little consensus on CRC screening decision-making influential factors between family practitioners, general internists, and patients. The recommendations to reach consensus are provided on the individual (e.g., updating the contents of a physician's screening recommendation to proactively address patients' decision-making needs) and population (e.g., providing cross-cultural training to medical students enabling them to better understand their patients) levels.
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Affiliation(s)
- Yelena N Tarasenko
- Department of Behavioral Science, College of Medicine, University of Kentucky, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA.
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Wackerbarth SB, Tarasenko YN, Curtis LA, Joyce JM, Haist SA. Using decision tree models to depict primary care physicians CRC screening decision heuristics. J Gen Intern Med 2007; 22:1467-9. [PMID: 17710501 PMCID: PMC2305850 DOI: 10.1007/s11606-007-0338-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 07/12/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to identify decision heuristics utilized by primary care physicians in formulating colorectal cancer screening recommendations. DESIGN Qualitative research using in-depth semi-structured interviews. PARTICIPANTS We interviewed 66 primary care internists and family physicians evenly drawn from academic and community practices. A majority of physicians were male, and almost all were white, non-Hispanic. APPROACH Three researchers independently reviewed each transcript to determine the physician's decision criteria and developed decision trees. Final trees were developed by consensus. The constant comparative methodology was used to define the categories. RESULTS Physicians were found to use 1 of 4 heuristics ("age 50," "age 50, if family history, then earlier," "age 50, if family history, then screen at age 40," or "age 50, if family history, then adjust relative to reference case") for the timing recommendation and 5 heuristics ["fecal occult blood test" (FOBT), "colonoscopy," "if not colonoscopy, then...," "FOBT and another test," and "a choice between options"] for the type decision. No connection was found between timing and screening type heuristics. CONCLUSIONS We found evidence of heuristic use. Further research is needed to determine the potential impact on quality of care.
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Affiliation(s)
- Sarah B Wackerbarth
- Martin School of Public Policy and Administration, University of Kentucky, 435 Patterson Office Tower, Lexington, KY, USA.
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5
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Adams WB, Joyce JM. One extra chocolate blizzard. Am J Hosp Palliat Care 2007; 24:248-9. [PMID: 17601852 DOI: 10.1177/1049909106296972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wackerbarth SB, Tarasenko YN, Joyce JM, Haist SA. Physician colorectal cancer screening recommendations: an examination based on informed decision making. Patient Educ Couns 2007; 66:43-50. [PMID: 17098393 PMCID: PMC3635666 DOI: 10.1016/j.pec.2006.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 08/12/2006] [Accepted: 10/04/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The purpose of this research was to examine the content of physicians' colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients. METHODS We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation. RESULTS Almost all of the physicians (98.5%) addressed the "nature of decision" element. A majority of physicians discussed "uncertainties associated with the decision" (67.7%). Fewer physicians covered "the patient's role in decision making" (33.8%), "risks and benefits" (16.9%), "alternatives" (10.8%), "assessment of patient understanding" (6.2%), or "exploration of patient's preferences" (1.5%). CONCLUSION We propose that the content of the colorectal screening recommendation is a critical determinant to whether a patient undergoes screening. Our examination of physician recommendations yielded mixed results, and the deficiencies identified opportunities for improvement. PRACTICE IMPLICATIONS We suggest primary care physicians clarify that screening is meant for those who are asymptotic, present tangible and intangible benefits and risks, as well as make a primary recommendation, and, if needed, a "compromise" recommendation, in order to increase screening utilization.
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Affiliation(s)
- Sarah B Wackerbarth
- Martin School of Public Policy and Administration, University of Kentucky, KY, USA.
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7
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Joyce JM, Love MM, Fordham M. Discovering gender differences while teaching family genograms. Med Educ 2006; 40:468-9. [PMID: 16635137 DOI: 10.1111/j.1365-2929.2006.02452.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Jennifer M Joyce
- Department of Family Practice and Community Medicine, K302 Kentucky Clinic, Kentucky 40536-0284, USA.
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Affiliation(s)
- Brian L Baker
- College of Medicine, University of Kentucky, Lexington, USA
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9
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Thompson CJ, Tam NNC, Joyce JM, Leav I, Ho SM. Gene expression profiling of testosterone and estradiol-17 beta-induced prostatic dysplasia in Noble rats and response to the antiestrogen ICI 182,780. Endocrinology 2002; 143:2093-105. [PMID: 12021174 DOI: 10.1210/endo.143.6.8846] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We previously demonstrated that 1) treatment of Noble rats for 16 wk with testosterone (T) and estradiol-17 beta (E2) led to 100% incidence of dorsolateral prostate (DLP) dysplasia and hyperprolactinemia and 2) blockade of PRL release with bromocriptine cotreatment significantly lowered the incidence of DLP dysplasia. In the current study, we sought to determine whether E2 exerts direct effects, independent of PRL, in this model system. The pure antiestrogen ICI 182,780 (ICI), reported to have no effect on PRL release in female rats, was administered biweekly to T + E2-treated rats at 3 mg/kg body weight. ICI cotreatment completely prevented DLP dysplasia development but it also blocked hyperprolactinemia in the dual hormone-treated rats. Gene profiling with an 1185 gene rat cDNA array identified approximately 100 genes displaying > or = 3-fold changes in rat lateral prostates (LPs) following T + E2 treatment. Significantly more genes were up-regulated (77) than down-regulated (14), reflecting cellular/molecular changes associated with enhanced cell proliferation, DNA damage, heightened protein and RNA synthesis, increased energy metabolism, and activation of several proto-oncogenes and intracellular signaling pathways. Post hoc analyses, using quantitative real-time RT-PCR, corroborated differential expression of eight genes, exhibiting three different patterns of altered expression. Genes encoding the early growth response protein 1 and metalloendopeptidase meprin beta-subunit were similarly altered in T + E2- and T + E2 + ICI-treated animals when compared with untreated controls. In contrast, transcripts of fos-related antigen-2, growth arrest and DNA damage-inducible protein-45, and signal transducer and activator of transcription-3 were significantly increased in the LPs of T + E2-treated animals, but the increases were reversed by cotreatment with ICI. Differential expression of fos-related antigen-2 and growth arrest and DNA damage-inducible protein-45 were further confirmed at the protein level by immunohistochemistry. Lastly, levels of A-RAF, VIP-1 receptor, and calpastatin mRNA were distinctly lessen in rat LPs under T + E2 influence, but rebound with ICI cotreatment. In conclusion, our findings further implicated pituitary PRL in the induction of dysplasia in rat LP. Gene profiling provided clues that molecular events related to enhancement of cell proliferation, DNA damage, and activation of proto-oncogenes and transforming factors may be causally linked to the genesis of LP dysplasia in this rat model.
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Affiliation(s)
- Christopher J Thompson
- Department of Surgery-Division of Urology, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
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10
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Affiliation(s)
- R J Thomas
- Department of Radiology, The Western Pennsylvania Hospital, Pittsburgh 15224, USA
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11
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Straka MR, Joyce JM, Myers DT. Tc-99m nofetumomab merpentan complements an equivocal bone scan for detecting skeletal metastatic disease from lung cancer. Clin Nucl Med 2000; 25:54-5. [PMID: 10634533 DOI: 10.1097/00003072-200001000-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M R Straka
- Department of Radiology, The Western Pennsylvania Hospital, Pittsburgh 15224, USA
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12
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Valliappan S, Joyce JM, Myers DT. Possible false-positive metastatic prostate cancer on an In-111 capromab pendetide scan as a result of a pelvic kidney. Clin Nucl Med 1999; 24:984-5. [PMID: 10595486 DOI: 10.1097/00003072-199912000-00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S Valliappan
- Department of Radiology, The Western Pennsylvania Hospital, Pittsburgh 15224, USA
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13
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Scorza LM, Myers DT, Joyce JM. Incidental detection of a popliteal pseudoaneurysm on bone scintigraphy. Clin Nucl Med 1999; 24:277-8. [PMID: 10466529 DOI: 10.1097/00003072-199904000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L M Scorza
- Department of Radiology, The Western Pennsylvania Hospital, Pittsburgh 15224, USA
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14
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Obuchowski CA, Joyce JM, Foster R, Bennett M. New method for detection of a bronchopleural fistula: direct instillation of Tc-99m DTPA into the pleural space via a thoracostomy tube. Clin Nucl Med 1998; 23:353-5. [PMID: 9619319 DOI: 10.1097/00003072-199806000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 65-year-old man who had undergone a right upper lobectomy for squamous cell carcinoma developed a persistent air space in the right superior thorax. Because a bronchopleural fistula was suspected, a new technique to demonstrate the fistula was used. Five mCi of Tc-99m DTPA was instilled through a pigtail catheter into the cavity. Radiotracer activity extended into the remaining right bronchial tree, trachea, and left bronchial tree on the 10 minute delayed image confirming the presence of a bronchopleural fistula. Using bronchoscopic guidance, the fistula was sealed with a fibrin plug. A repeat examination 4 days later revealed no extension of tracer from the cavity up to 60 minutes after instillation, indicating successful sealing of the fistula. This technique offers a rapid, inexpensive, and portable diagnosis of bronchopleural fistula.
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Affiliation(s)
- C A Obuchowski
- Department of Radiology, Western Pennsylvania Hospital, Pittsburgh 15224, USA
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15
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Affiliation(s)
- A E Lamont
- Department of Radiology, Western Pennsylvania Hospital, Pittsburgh 15224, USA
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16
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Grabb BC, Joyce JM, Grossman SJ, Weinbaum DL. Clinically unsuspected epiglottitis detected by indium-111-white blood cell scintigraphy. J Nucl Med 1996; 37:76-7. [PMID: 8544006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A 62-yr-old woman with a history of mental retardation, paranoid psychosis and agitated depression presented with deterioration in her baseline mental status and fever. No obvious source of fever was found on clinical exam or on initial laboratory studies. An 111In-white blood cell (111In-WBC) study was performed 1 wk after hospital admission, which revealed increased uptake in the anterior neck and oral cavity. Subsequent laryngoscopy revealed a red, swollen epiglottis compatible with epiglottitis. While not advocating 111In-WBC scintigraphy as part of the workup of epiglottitis, this case is presented to emphasize the possible milder presentation of epiglottitis in adults compared to children.
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Affiliation(s)
- B C Grabb
- Department of Radiology, Western Pennsylvania Hospital, Pittsburgh 15224, USA
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Affiliation(s)
- A R Forauer
- Department of Radiology, Western Pennsylvania Hospital, Pittsburgh 15224
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Joyce JM, Idea RJ, Grossman SJ, Liss RG, Lyons JB. Multiple brown tumors in unsuspected primary hyperparathyroidism mimicking metastatic disease on radiograph and bone scan. Clin Nucl Med 1994; 19:630-5. [PMID: 7924108 DOI: 10.1097/00003072-199407000-00016] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J M Joyce
- Department of Radiology, West Penn Hospital, Pittsburgh, Pennsylvania 15224
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19
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Vertosick FT, Selker RG, Grossman SJ, Joyce JM. Correlation of thallium-201 single photon emission computed tomography and survival after treatment failure in patients with glioblastoma multiforme. Neurosurgery 1994; 34:396-401. [PMID: 8190213 DOI: 10.1227/00006123-199403000-00002] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
After initial radiotherapy for an intracranial malignant glioma, the majority of patients return at a later date with a recurrent, enhancing mass on computed tomography or magnetic resonance imaging. This mass represents either recurrent tumor, radionecrosis, or a combination of the two. The relative proportion of live versus dead tumor cells is difficult to determine from surgical specimens of another biopsy, although this has been the preferred method of assessing such "failed" patients. Recently, attention has turned to tomographic images of metabolic markers, i.e., positron emission tomography and thallium-201 (Tl-201) single photon emission computed tomography, as noninvasive methods of assessing relative tumor viability. To assess whether Tl-201 uptake in vivo can be used as a prognostic indicator in patients with glioblastoma multiforme, we measured the ratio of Tl-201 uptake in tumor to Tl-201 uptake in myocardium (T/C ratio) in 16 patients at the point of treatment "failure" and followed all the patients until they died. All patients died of neurological causes, and 11 of the 16 patients had documented viable tumor recurrence. There was a significant negative correlation between the T/C ratio at failure and the time interval between failure and death (r = -0.602, P = 0.014). Patients with T/C ratios of less than 0.3 lived an average of 13 months, whereas patients with T/C ratios of more than 0.3 lived an average of only 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F T Vertosick
- Department of Surgery, Western Pennsylvania Hospital, Pittsburgh
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20
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Winzelberg GG, Grossman SJ, Rizk S, Joyce JM, Hill JB, Atkinson DP, Sudina K, Anderson K, McElwain D, Jones AM. Indium-111 monoclonal antibody B72.3 scintigraphy in colorectal cancer. Correlation with computed tomography, surgery, histopathology, immunohistology, and human immune response. Cancer 1992; 69:1656-63. [PMID: 1551051 DOI: 10.1002/1097-0142(19920401)69:7<1656::aid-cncr2820690704>3.0.co;2-n] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
As part of an open-labeled nonrandomized multi-institutional Phase III study, the authors compared the results of In-111 (In-111) B72.3 glycyl-tyrosyl-n-diethylenetriaminepentaacetic acid lysine (GYK-DTPA) monoclonal antibody scintigraphy with computed tomography (CT), surgery, histopathology, immunohistology, and human antibody response in 23 patients with primary colorectal carcinoma. There were no significant adverse reactions to 1 mg of In-111-labeled antibody. Planar imaging identified 16 of 23 primary colon lesions, whereas single photon emission computer tomography (SPECT) imaging identified 21. SPECT also correctly identified lymphatic involvement in four patients. (There were two false-positive results.) Liver metastases were identified with SPECT imaging. Twenty-six percent of patients developed human anti-mouse antibody (HAMA). These preliminary results demonstrate that In-111 B72.3 GYK-DTPA is a safe monoclonal antibody conjugate that has a high sensitivity for identifying primary colorectal cancer. Regional lymphatic and distant liver metastases also can be imaged, but false-positive results can occur.
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Affiliation(s)
- G G Winzelberg
- Department of Nuclear Medicine, Shadyside Hospital, Pittsburgh, PA 15232
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21
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Joyce JM, Grossman SJ. Scrotal scintigraphy in testicular torsion. Emerg Med Clin North Am 1992; 10:93-102. [PMID: 1732099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Testicular torsion is a surgical emergency that requires prompt diagnosis and treatment to maximize testicular survival. When the clinical diagnosis is uncertain, testicular scintigraphy can be performed to evaluate testicular perfusion. This noninvasive imaging study is widely validated and highly accurate in predicting nontorsion, which excludes the need for exploration.
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Affiliation(s)
- J M Joyce
- Section of Nuclear Medicine, Western Pennsylvania Hospital, Pittsburgh
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22
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Grossman SJ, Joyce JM. Hepatobiliary imaging. Emerg Med Clin North Am 1991; 9:853-74. [PMID: 1915052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient's clinical presentation should prompt an imaging evaluation that is cost effective for accurate diagnosis and leads to appropriate treatment of gallbladder inflammatory disease. In the setting of recurrent biliary colic, chronic cholecystitis is the main diagnostic consideration. Imaging hallmarks include gallstones and gallbladder wall thickening for which ultrasonography is uniquely suited. When a patient appears more toxic with right upper quadrant pain, one would more strongly consider acute cholecystitis. Because the morbidity and mortality of acute cholecystitis are reduced with early cholecystectomy, it is incumbent upon the clinician to make the diagnosis promptly and accurately. Hepatobiliary imaging with an IDA derivative has proven superior sensitivity, specificity, and accuracy for this condition. The examination has validity because it detects cystic duct obstruction, the primary pathophysiologic event responsible for most acute calculous and acalculous disease. Utilizing morphine augmentation when delayed filling is present has reduced the total examination time to less than 2 hours. Use of ancillary findings including gallbladder hyperemia and the "hot rim" sign help predict complicated cholecystitis, enabling more urgent intervention. The bulk of data presented in this review supports hepatobiliary imaging as the modality of first choice in the evaluation of acute cholecystitis. In the intensive care setting, where acalculous disease and atypical presentations are common, hepatobiliary imaging also plays a major role. We recommend liberal use of Sincalide pretreatment, morphine augmentation, and delayed images to promote gallbladder filling. If the gallbladder is nonvisualizing despite these maneuvers, sonography is often added as an aid to detect secondary signs of acute cholecystitis and help confirm the diagnosis with greater certainty prior to high-risk surgery.
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Affiliation(s)
- S J Grossman
- Nuclear Medicine, Western Pennsylvania Hospital, Pittsburgh
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McCabe JL, Grossman SJ, Joyce JM. Ventilation-perfusion scintigraphy. Emerg Med Clin North Am 1991; 9:805-25. [PMID: 1915050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ventilation-perfusion scintigraphy remains an important diagnostic tool in the evaluation of patients suspected of having PE. It is important for the emergency physician to be able to use the information from a lung scan appropriately in the diagnostic management of this elusive and life-threatening disorder. This requires a clear knowledge of how these scans are interpreted as well as a consultative approach between the physician ordering the lung scan and the nuclear medicine physician interpreting it. Each can ultimately contribute to the development of an effective management plan. It is important for the clinician to understand that a low-probability lung scan does not rule out PE, but in fact can have up to a 40% probability of PE when clinical suspicion is high.
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Affiliation(s)
- J L McCabe
- University of Pittsburgh Affiliated Residency in Emergency Medicine, Pennsylvania
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Affiliation(s)
- J M Joyce
- Veterans Administration, Lexington, KY
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Kacki MH, Joyce JM, Coupal JJ, Ryo UY. Lung uptake on Tc-99m albumin colloid liver spleen scan and on Ga-67 scan in angiotropic lymphoma. Clin Nucl Med 1990; 15:187-9. [PMID: 2318001 DOI: 10.1097/00003072-199003000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lung uptake of Tc-99m sulfur colloid has been reported in various hepatic and extrahepatic diseases, and lung uptake of gallium-67 may occur in patients with various interstitial lung disease without radiographic abnormality. This may be the first case of Tc-99m albumin colloid and Ga-67 lung uptake in a patient with angiotropic lymphoma of the liver, spleen, and uterus.
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Affiliation(s)
- M H Kacki
- Department of Diagnostic Radiology, University of Kentucky Medical Center, Lexington 40536
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26
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Joyce JM, Warren DL, Humphries LL, Smith AJ, Coon JS. Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation. J Nucl Med 1990; 31:325-31. [PMID: 2308003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Osteoporosis has been reported in anorexia nervosa (AN), but not in other eating disorders. Thirty-three patients, 8 AN, 17 bulimia nervosa (BN), and 8 eating disorder not otherwise specified (EDNOS), were evaluated by bone densitometry (radius, spine, femur) to determine the prevalence and distribution of osteoporosis and the role of physical parameters, exercise and estrogen. All three diagnostic subgroups had evidence of decreased bone density, worst in the EDNOS subgroup and least in the BN subgroup. The most affected site was the femur, least the spine; the radius was intermediate. Age, body surface area, age of onset, and length of illness weakly correlated with the femur and spine density in the BN and EDNOS subgroups. Exercise was related to bone density in the AN subgroup in the femur, moderate exercise having a protective effect and strenuous exercise being detrimental. No significant correlation of bone density measurements with estradiol levels and/or history of amenorrhea was identified. Eating disorder patients are at risk for osteoporosis, which has multiple contributing factors including physical parameters and exercise. Estrogen deficiency by itself may not be a major causative factor.
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Affiliation(s)
- J M Joyce
- Department of Radiology, Western Pennsylvania Hospital, Pennsylvania 15224
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Affiliation(s)
- J M Joyce
- University of Kentucky Medical Center, Lexington
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Joyce JM, Aubrey DL, MacDonald JS, Ryo UY. Lung uptake of technetium-99m HDP in giant-cell tumor metastases. Clin Nucl Med 1989; 14:767-8. [PMID: 2805529 DOI: 10.1097/00003072-198910000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J M Joyce
- University of Kentucky Medical Center, Lexington
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Dryja TP, Rapaport JM, Joyce JM, Petersen RA. Molecular detection of deletions involving band q14 of chromosome 13 in retinoblastomas. Proc Natl Acad Sci U S A 1986; 83:7391-4. [PMID: 2876425 PMCID: PMC386723 DOI: 10.1073/pnas.83.19.7391] [Citation(s) in RCA: 172] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
DNA fragments from a locus spanning 29 kilobases within chromosome band 13q14 detected deletions in 3 retinoblastomas out of 37 such tumors examined. Somatically occurring, homozygous deletions spanning at least 25 kilobases were detected in retinoblastomas from two unrelated patients. These deletions are bounded by the esterase D locus proximally. In a third patient, both tumor cells and leukocytes have a deletion of one chromosome 13 homolog, with one end of the deletion localized to a 1.55-kilobase fragment within the cloned region. It is likely that the cloned locus is within a few hundred kilobases of the retinoblastoma gene (i.e., the locus governing predisposition to such tumors) and that the deletions detected also involve the retinoblastoma gene. Further, it may be possible to base a successful approach to the isolation of the retinoblastoma gene on this assumed physical proximity of the two loci.
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Gaiser JE, Joyce JM, Bissinger G. Continuum electron intramolecular outscattering from bare MeV/u H and He projectiles traversing hydrocarbon gases. Phys Rev A Gen Phys 1986; 34:127-129. [PMID: 9897233 DOI: 10.1103/physreva.34.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Abstract
Disuse osteoporosis, a common sequela to immobilization, consists of bony changes that may mimic neoplastic disease. This paper describes the different types of cortical and medullary demineralization that can be manifested radiologically and the histopathologic basis for these alterations. Six cases are included that exemplify these changes, and comparison is made with multiple myeloma.
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Bissinger G, Gaiser J, Joyce JM, Numan M. Wake formation by megaelectronvolt-per-nucleon bare H and He ions in large hydrocarbon molecules? Phys Rev Lett 1985; 55:197-200. [PMID: 10032026 DOI: 10.1103/physrevlett.55.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Varghese SL, Bissinger G, Joyce JM, Laubert R. Atomic total electron-capture cross sections from C-, O-, F-, and S-bearing molecular gases for ~MeV/u H+ and He+ projectiles. Phys Rev A Gen Phys 1985; 31:2202-2209. [PMID: 9895751 DOI: 10.1103/physreva.31.2202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
The occurrence of metaphyseal cortical irregularities in adolescents in many different bones indicates a commonality of these lesions as a variation of normal growth, rather than a stress or avulsive by-product. The histologically recognized incomplete nature of the metaphysial cortex in children offers an attractive explanation for this phenomenon.
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Walter RL, Willis RD, Gutknecht WF, Joyce JM. Analysis of biological, clinical, and environmental samples using proton-induced X-ray emission. Anal Chem 1974; 46:843-55. [PMID: 4840589 DOI: 10.1021/ac60343a038] [Citation(s) in RCA: 82] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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